Analysis of Serum Cys-C,TBA,and Routine Blood Parameters of Patients with Hepatitis B-Related Decompensated Cirrhosis

Objective:To study the levels of serum cystatin C(Cys-C),total bile acid(TBA),and other routine blood parameters on patients with decompensated hepatitis B cirrhosis.Methods:Study group 1 consisted of 30 patients with hepatitis B-related decompensated cirrhosis,and study group 2 consisted of 30 patients with hepatitis B;while the control group consisted of 30 healthy people who underwent physical examination.The blood parameters were used to evaluate the clinical treatment effect of patients.Results:The TBA,Cys-C,alanine transaminase(ALT),total bilirubin(TBIL),aspartate aminotransferase(AST),and international normalized ratio(INR)in study group 1 were significantly higher than those of study group 2 and the control group;while the platelet count(PLT),hemoglobin(Hb),albumin(ALB),and estimated glomerular filtration rate(eGFR)were significantly lower in the study group 1 compared to the control group and study group 2(P<0.05).The Cys-C,PLT,TBA,AST,TBIL,and INR of patients in study group 1 who were successfully treated were significantly lower than the patients who were not successfully treated(P<0.05).Conclusion:Serum Cys-C,TBA,and routine blood parameters are useful in predicting the condition and the prognosis of patients of hepatitis B-related decompensated cirrhosis.

Validation of the albumin-bilirubin score for identifying decompensation risk in patients with compensated cirrhosis

BACKGROUND The albumin-bilirubin(ALBI)score is an index of liver function recently developed to assess prognosis in patients with hepatocellular carcinoma(HCC).It can detect small changes in liver dysfunction and has been successfully applied to the prediction of survival in patients with non-malignant liver diseases of various etiologies.AIM To investigate the ALBI score for identifying decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.METHODS One-hundred and twenty-three patients with compensated cirrhosis without HCC in King Chulalongkorn Memorial Hospital diagnosed by imaging were retrospectively enrolled from January 2016 to December 2020.A total of 113 patients(91.9%)had Child A cirrhosis with a median model for end-stage liver disease(MELD)score of less than 9.Baseline clinical and laboratory variables and decompensation events were collected.The ALBI score was calculated and validated to classify decompensation risk into low-,middle-,and high-risk groups using three ALBI grade ranges(ALBI grade 1:≤-2.60;grade 2:>-2.60 but≤-1.39;grade 3:>-1.39).Decompensation events were defined as ascites development,variceal bleeding,or grade 3 or 4 hepatic encephalopathy.RESULTS Among 123 cirrhotic patients enrolled,13.8%(n=17)developed decompensating events at a median time of 25[95%confidence interval(CI):17-31]mo.Median baseline ALBI score in compensated cirrhosis was significantly lower than that of patients who developed decompensation events[-2.768(-2.956 to-2.453)vs-2.007(-2.533 to-1.537);P=0.01].Analysis of decompensation risk at 3 years showed that ALBI score had a time-dependent area under the curve(tAUC)of 0.86(95%CI:0.78-0.92),which was significantly better than that of ALBI-Fibrosis-4(ALBI-FIB4)score(tAUC=0.77),MELD score(tAUC=0.66),Child-Pugh score(tAUC=0.65),and FIB-4 score(tAUC=0.48)(P<0.05 for all).The 3-year cumulative incidence of decompensation was 3.1%,22.6%,and 50%in the low-,middle-,and high-risk groups,respectively(P<0.001).The odds ratio for decompensation in patients of the high-risk group was 23.33(95%CI:3.88-140.12,P=0.001).CONCLUSION The ALBI score accurately identifies decompensation risk at the 3-year follow-up in patients with compensated cirrhosis.Those cirrhotic patients with a high-risk grade of ALBI score showed a 23 times greater odds of decompensation.

Effect of Qianggan Pills combined with antiviral treatment on the fibrosis indexes, immune and inflammatory response in patients with compensated hepatitis b cirrhosis

Objective:To study the effect of Qianggan Pills combined with antiviral treatment on the fibrosis indexes, immune and inflammatory response in patients with compensated hepatitis b cirrhosis.Methods:A total of 88 patients with compensated hepatitis b cirrhosis treated in our hospital between April 2013 and March 2016 were collected and divided into observation group and control group according to single blind randomized control. Observation group of patients accepted Qianggan Pills combined with antiviral treatment and control group of patients received antiviral treatment alone. After 6 months of treatment, chemiluminescence method was used to detect serum fibrosis indexes, flow cytometer was used to detect peripheral blood T lymphocyte subset levels, and enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of inflammatory factors.Results: Before treatment, differences in fibrosis indexes, immune and inflammatory response indexes were not statistically significant between two groups of patients;after 6 months of treatment, serum LN, HA andⅣ-C levels of observation group were lower than those of control group, peripheral blood CD3+ and CD4+T lymphocyte levels as well as CD4+/CD8+ ratio were higher than those of control group, and CD8+ T lymphocyte level was lower than that of control group;serum PCT and CRP levels were lower than those of control group while IL-10 and IL-13 levels were higher than those of control group.Conclusion:Qianggan Pills combined with antiviral treatment can inhibit the fibrosis process, strengthen the body's immune function and also relieve systemic inflammatory response in patients with compensated hepatitis b cirrhosis.

Clinical efficacy of antiviral therapy in patients with hepatitis Brelated cirrhosis after transjugular intrahepatic portosystemic shunt

BACKGROUND As a country with a high burden of hepatitis B,China has about 86 million cases of hepatitis B virus infection,ranking the first in the world.Currently,there are about 390000 deaths due to hepatitis B-related complications such as liver cirrhosis and liver cancer every year.Consequently,how to control portal hypertension,improve liver functional reserve,and reduce the incidence of hepatic failure and liver cancer in such patients is the focus of current clinical attention.Previous clinical study in our center suggested that at 24 mo after transjugular intrahepatic portosystemic shunt(TIPS),the liver functional reserve of patients with hepatitis B cirrhosis was better than that of patients with alcoholinduced and immune cirrhosis,which may be related to the effective etiological treatment.AIM To investigate the clinical efficacy of three first-line antiviral drugs recommended by the guidelines of prevention and treatment for chronic hepatitis B in China(2019)in the treatment of patients with hepatitis B-related cirrhosis who had received a TIPS.METHODS The clinical data of 137 patients with hepatitis B-related cirrhosis with portal hypertension after receiving TIPS at our centre between March 2016 and December 2020 were analysed retrospectively.According to different anti-viral drugs,the patients were divided into entecavir(ETV)(n=70),tenofovir alafenamide fumarate(TAF)(n=32),and tenofovir disoproxil fumarate(TDF)(n=35)groups.The cumulative incidence of hepatic encephalopathy and hepatocellular carcinoma,survival,and changes in hepatic reserve function and glomerular filtration rate in patients treated with different antiviral drugs within 24 mo after surgery were investigated.RESULTS At 24 mo after surgery,the Child-Pugh score in the TAF group(6.97±0.86)was lower than that in the TDF(7.49±0.82;t=-2.52,P=0.014)and ETV groups(7.64±1.17;t=-2.92,P=0.004).The model for end-stage liver disease score in the TAF group at 24 mo after surgery was 9.72±1.5,which was lower than that in the TDF(10.74±2.33;t=-2.09,P=0.040)and ETV groups(10.97±2.17;t=-2.93,P=0.004).At 24 mo after surgery,the estimated glomerular filtration rate(eGFR)in the TAF group(104.41±12.54)was higher than that in the TDF(93.54±8.97)and ETV groups(89.96±9.86)(F=21.57,P<0.001).CONCLUSION At 24 mo after surgery,compared with TDF and ETV,TAF has significant advantages in the improvement of liver functional reserve and eGFR.

Efficacy observation of Yiguanjian decoction combined adefovir Dipivoxil tablet in treating HBeAg negative chronic viral hepatitis B active compensated liver cirrhosis patients

Objective To explore clinical efficacy of Yiguanjian Decoction(YD)combined Adefovir Dipivoxil Tablet(ADT)in treating HBe Ag negative chronic viral hepatitis B(CVHB)active compensated liver cirrhosis(LC)patients.Methods Totally 68 HBe Ag negative CVHB active compensated LC patients initially treated were assigned to the treatment group and the control group

复方鳖甲软肝片联合恩替卡韦治疗慢性乙型肝炎肝硬化代偿期临床研究

目的:观察复方鳖甲软肝片联合恩替卡韦治疗慢性乙型肝炎肝硬化代偿期的疗效,分析该治法对患者肝功能、纤维化指标的影响。方法:选择70例慢性乙型肝炎肝硬化患者为研究对象,按照自愿原则分为恩替卡韦组和鳖甲软肝组各35例。恩替卡韦组予以恩替卡韦片治疗,鳖甲软肝组在恩替卡韦组的基础上予以复方鳖甲软肝片治疗。比较2组临床疗效、不良反应,比较2组治疗前后肝功能、肝纤维化指标。结果:2组治疗总有效率、不良反应总发生率比较,差异均无统计学意义(P>0.05)。治疗后,2组总胆红素(TBil)、丙氨酸转移酶(ALT)及天门冬氨酸转移酶(AST)水平均下降(P<0.05),且鳖甲软肝组低于恩替卡韦组(P<0.05)。治疗后,2组透明质酸(HA)、层粘蛋白(LN)以及Ⅲ型前胶原(PcⅢ)水平均下降(P<0.05),且鳖甲软肝组低于恩替卡韦组(P<0.05),2组Ⅳ型胶原(Ⅳ-C)水平均升高(P<0.05),且鳖甲软肝组高于恩替卡韦组(P<0.05)。治疗后,2组肝脏弹性硬度明显下降(P<0.05),且鳖甲软肝组低于恩替卡韦组(P<0.05)。结论:复方鳖甲软肝片联合恩替卡韦能够明显改善慢性乙型肝炎肝硬化患者的肝功能,并抑制和逆转肝纤维化进程,且不增加不良反应。

替诺福韦与恩替卡韦治疗代偿期乙肝肝硬化患者的效果

目的探讨代偿期乙肝肝硬化患者接受替诺福韦与恩替卡韦治疗效果。方法选取2021年5月—2022年5月淄博市传染病医院收治的代偿期乙肝肝硬化患者70例,采用随机数字表法分为对照组与观察组,各35例。对照组采用恩替卡韦治疗,观察组采用替诺福韦治疗。对比2组临床疗效、肝功能、肝纤维化指标、乙肝病毒的脱氧核糖核酸(HBV deoxyribonucleic acid,HBV-DNA)转阴率、血小板与天冬氨酸转氨酶和血小板比率指数(aspartate aminotransferase to platelet ratio index,APRI)指数、脏器形态变化和并发症。结果观察组总有效率为97.14%,高于对照组的80.00%(P<0.05)。2组治疗后与治疗前比较谷草转氨酶、谷丙转氨酶、Child-Pugh评分均较低;治疗后,观察组谷草转氨酶、谷丙转氨酶、Child-Pugh评分均低于对照组,差异有统计学意义(P<0.05)。治疗前,2组血清层粘连蛋白、透明质酸、Ⅲ型前胶原肽水平比较,差异无统计学意义(P>0.05)。2组治疗后与治疗前比较,血清层粘连蛋白、透明质酸、Ⅲ型前胶原肽均较低;治疗后观察组血清层粘连蛋白、透明质酸、Ⅲ型前胶原肽均低于对照组,差异有统计学意义(P<0.05)。2组治疗后与治疗前相比,血小板计数较高、天冬氨酸氨基转移酶和血小板比率指数较低;治疗后,观察组血小板计数较高、天冬氨酸氨基转移酶和血小板比率指数均低于对照组,差异有统计学意义(P<0.05)。2组治疗后与治疗前比较肝门静脉内径较低、脾脏厚度较低;治疗后,观察组肝门静脉内径较低、脾脏厚度均低于对照组,差异有统计学意义(P<0.05)。2组治疗180 d与治疗90 d比较,HBV-DVA转阴率均较高;治疗后,观察组HBV-DVA转阴率均高于对照组,差异有统计学意义(P<0.05)。结论恩替卡韦联合替诺福韦治疗代偿期乙肝肝硬化可获得突出的治疗效果,可有效改善患者的肝功能指标,还可对乙肝病毒载量进行有效阻断。

双歧杆菌三联活菌联合多烯磷脂酰胆碱对乙型肝炎肝硬化代偿期患者肠道菌群和免疫功能的影响

目的探讨双歧杆菌三联活菌联合多烯磷脂酰胆碱辅助治疗乙型肝炎(简称乙肝)肝硬化代偿期的临床疗效,以及对患者肠道菌群、免疫功能的影响。方法选取沧州市人民医院2020年8月至2022年8月收治的乙肝肝硬化代偿期患者102例,按随机数字表法分为观察组和对照组,各51例。两组患者均予常规治疗,并予多烯磷脂酰胆碱注射液静脉滴注,观察组患者加服双歧杆菌三联活菌胶囊。两组均连续治疗3个月。结果观察组总有效率显著高于对照组(92.16%比74.51%,P<0.05)。两组患者总胆红素、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶及血清层粘连蛋白水平均显著降低(P<0.05),肠道中肠球菌、双歧杆菌、乳酸杆菌、拟杆菌数量均显著增加,酵母样真菌数量均显著减少(P<0.05);T淋巴细胞亚群CD_(4)^(+)、CD_(8)^(+)水平及CD_(4)^(+)/CD_(8)^(+)均改善;且观察组上述指标改善更显著(P<0.05)。结论双歧杆菌三联活菌联合多烯磷脂酰胆碱辅助治疗乙肝肝硬化代偿期,可有效缓解患者的临床症状,纠正肠道菌群失调状态,改善免疫功能,促进肝功能恢复。

安络化纤丸辅助治疗对乙肝肝硬化代偿期患者抗肝纤维化的影响

目的探讨安络化纤丸辅助治疗对乙肝肝硬化代偿期患者抗肝纤维化的影响。方法选择2020年5月—2022年5月聊城市传染病医院收治的106例乙肝肝硬化代偿期患者为研究对象,根据随机抽签法分为对照组与研究组,各53例。对照组患者给予替诺福韦治疗,研究组患者在对照组基础上联合口服安络化纤丸进行辅助治疗,连续治疗1年后比较两组治疗效果、抗肝纤维化指标[透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原蛋白(Ⅳ-C)]水平、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TB)]水平、病毒[乙肝病毒核酸(HBV-DNA)]载量、炎症细胞因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(Hs-CRP)]水平、肝脏硬度及用药安全性。结果研究组患者治疗总有效率较对照组高,差异有统计学意义(P<0.05)。治疗前,两组患者肝纤维化各指标水平比较,差异无统计学意义(P>0.05);治疗后,研究组患者HA、LN、PⅢP、Ⅳ-C水平均低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者ALT、AST、TB与HBV-DNA载量水平比较,差异无统计学意义(P>0.05);治疗后,研究组患者ALT、AST、TB与HBV-DNA载量水平均低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者IL-6、TNF-α、Hs-CRP水平及肝脏硬度比较,差异无统计学意义(P>0.05);治疗后,研究组患者IL-6、TNF-α、Hs-CRP水平及肝脏硬度均低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05),且两组均未发生严重不良反应。结论安络化纤丸辅助治疗可有效提升抗肝纤维化及抗病毒效果,抑制炎症反应,且安全性较高,值得临床应用。

Detection of carboxyhemoglobin in patients with hepatic encephalopathy due to hepatitis B virus-related cirrhosis

Background The heme oxygenase/carbon monoxide （HO/CO） system plays an important role in the development of hepatic fibrosis. The level of the HO/CO can be directly obtained by determining the carboxyhemoglobin （COHb） level. The aims of this study were to reveal the significance of COHb in patients with hepatitis B virus-related cirrhosis （HBC） complicated by hepatic encephalopathy （HE）, and to further investigate the influence of the HO/CO pathway on the end-stage cirrhosis, hoping to find a reliable indicator to evaluate the course of HBC. Methods According to the diagnostic criteria, 63 HBC inpatients with HE were enrolled in group H. Patients regaining awareness with current therapies were categorized into group P-H. Comparisons were made with a control group （group N） consisting of 20 health volunteers. The levels of COHb, partial pressure of oxygen （PaO2） and oxygen saturation （SaO2） were determined by arterial blood gas analysis method. The incidences of hepatorenal syndrome （HRS）, upper gastrointestinal bleeding, esophagogastric varices and spontaneous bacterial peritonitis （SBP） in group H were recorded. COHb levels in different groups were compared, and the correlations of COHb levels with HE grades （I, II, III, and IV）, PaO2, SaO2 and hypoxemia were analyzed. Results The COHb level in group P-H （（1.672＋0.761）%） was significantly higher than that in group N （（0.983±0.231）%） （P 〈0.01 ）, and the level in group H （（2.102±1.021）%） was significantly higher than groups P-H and N （P 〈0.01 ）. A positive correlation was observed between the COHb concentration and the grade of HE （rs=0.357, P=-0.004）. There were no significant differences of COHb levels between HE patients with and without complications such as esophagogastric varices （（2.302±1.072）% vs. （1.802±1.041）%, P 〉0.05） or the occurrence of SBP （（2.960±0.561）% vs. （2.030±1.021）%, P 〉0.05）. Compared with HE patients with HRS, the level of COHb was significantly higher in HE patients without HRS （（2.502±1.073）% vs. （1.981＋1.020）%, P=0.029）. The COHb level had a negative correlation with PaO2 （r=-0.335, P=0.007） while no statistically significant relationship was found with SaO2 （r=-0.071, P 〉0.05）. However, when the above two parameters met the diagnostic criteria of hypoxemia, the COHb concentration increased （（2.621±0.880）% vs. （1.910±0.931）%, P=0.011 ）. Conclusions COHb is a potential candidate to estimate the severity and therapeutic effect of HE. The levels of COHb may be tissue-specific in cirrhotic patients with different complications.

220例血清HBV DNA≤2000 IU/mL的代偿期肝硬化患者肝功能评价指标、并发症分析

目的了解血清乙型肝炎病毒(HBV)DNA≤2000 IU/mL的乙型肝炎病毒(HBV)相关代偿期肝硬化患者的肝功能及并发症发生情况,为后续临床诊疗提供依据。方法220例血清HBV DNA≤2000IU/mL的HBV相关代偿期肝硬化患者,收集其肝功能评价指标资料和并发症资料。结果220例患者肝功能生化指标血清甲胎蛋白为4.80(2.12,8.35)ng/mL、总胆红素为18.90(14.10,28.76)μmol/L,白蛋白为39.35(34.60,43.90)g/L、肌酐为64(56,73.52)μmol/L、丙氨酸转氨酶为31.73(21.12,52.17)U/L、天冬氨酸转氨酶为30.35(23.85,48.85)U/L、γ-谷氨酰转肽酶42.70(24,66.08)U/L、碱性磷酸酶为82.05(63.38,113)U/L、血小板为105(57.25,158)×109/L、凝血酶原活动度为81.03%(66%,93.97%)、国际标准化比值为1.09(1.02,1.21);肝功能CTP分级以A级为主,终末期肝病模型评分(8.91±3.78)分、天冬氨酸转移酶及血小板比率指数(1.63±2.83)分、基于4因子的肝纤维化指数评分(4.84±5.28)分。220例患者中HBV DNA阳性(血清HBV DNA 100~2000 IU/mL)49例、乙肝表面抗原阳性183例、乙肝e抗原阳性151例。220例患者并发症发生情况为脾大103例、脾功能亢进110例、食管胃底静脉曲张74例、门静脉血栓6例、HCC 6例。与其他年龄比较,年龄<40岁的HBV相关代偿期肝硬化患者脾大发生率高(χ^(2)=6.864,P<0.05)。结论虽然血清HBV DNA≤2000 IU/mL的代偿期HBV相关肝硬化患者的肝功能基本正常,但部分指标处于正常范围的低值。血清HBV DNA≤2000 IU/mL的代偿期HBV相关肝硬化患者脾大、脾功能亢进等并发症发生率较高。

软肝抗纤方联合恩替卡韦与维生素D3治疗乙型肝炎肝硬化代偿期患者的临床疗效及对其免疫功能的影响

目的 探讨软肝抗纤方联合恩替卡韦与维生素D3对乙型肝炎肝硬化(Hepatitis B cirrhosis, HBC)代偿期患者的临床疗效及免疫功能的影响。方法 选取2021年1月—2022年1月期间华北石油管理局总医院门诊收治的代偿期HBC患者120例,按照随机数字表法分为对照组和观察组,每组各60例。对照组予恩替卡韦加维生素D3治疗,观察组在对照组基础上联用软肝抗纤方治疗。治疗24周后,观察比较两组患者临床疗效,治疗前后肝功能指标[天门冬氨酸氨基转移酶(Aspartate aminotransferase, AST)、丙氨酸氨基转移酶(Alanine aminotransferase, ALT)、白蛋白(Albumin, ALB)和总胆红素(Total bilirubin, TBil)]、肝纤维化指标[层黏连蛋白(Laminin, LN)、透明质酸(Hyaluronic acid, HA)、Ⅲ型前胶原(Type III procollagen, PCⅢ)、Ⅳ型胶原(Type IV collagen,Ⅳ-C)]、免疫功能指标[CD4^(+)、CD8^(+),并计算CD4^(+)/CD8^(+)],评价中医证候评分与慢性肝脏疾病特异性量表(The chronic liver disease-specific questionnaire, CLDQ)评分。结果 治疗24周后两组患者中医证候评分较治疗前降低,差异有统计学意义(P<0.05);且观察组评分低于对照组,差异有统计学意义(P<0.05)。治疗24周后观察组总有效率96.67%(58/60)高于对照组83.33%(50/60),差异有统计学意义(P<0.05)。治疗24周后肝功能指标AST、ALT和TBil均较治疗前降低,ALB较治疗前升高,差异有统计学意义(P<0.05);且观察组肝功能指标ALT、AST和TBil低于对照组,ALB高于对照组,差异有统计学意义(P<0.05)。治疗24周后,两组患者肝纤维化指标LN、HA、PCⅢ和Ⅳ-C均较治疗前降低,差异有统计学意义(P<0.05);且观察组低于对照组,差异有统计学意义(P<0.05)。治疗24周后两组患者CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)均较治疗前升高,差异有统计学意义(P<0.05);且观察组CD4^(+)、CD4^(+)/CD8^(+)高于对照组,差异有统计学意义(P<0.05);CD8^(+)与对照组比较,差异无统计学意义(P>0.05)。治疗24周后两组患者生活质量CLDQ评分均较治疗前升高,差异有统计学意义(P<0.05);且观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良反应率5.00%(3/60)与对照组1.67%(1/60)比较,差异无统计学意义(P>0.05)。结论 软肝抗纤方联合恩替卡韦与维生素D3治疗HBC可提高临床疗效,调节免疫功能,改善临床症状及肝功能,改善肝纤维化。

核苷(酸)类似物治疗乙型肝炎肝硬化代偿期达到“功能性治愈”后停药的影响

目的观察核苷(酸)类似物(NAs)治疗乙型肝炎肝硬化代偿期患者达到“功能性治愈”后停药的影响。方法回顾性收集2019年5月—2020年5月于荆州市第二人民医院行NAs治疗的乙型肝炎肝硬化代偿期患者95例,其中达到“功能性治愈”后停药患者40例作为停药组,继续用药患者55例作为继续用药组,对2组患者进行为期24个月的随访。比较2组达到“功能性治愈”与随访6、12、24个月的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清总胆红素(TBil)、HBV-DNA载量及抗-HBs、乙型肝炎E抗原(HBeAg)阳性率,比较2组患者复发率、原发性肝癌发生率及肝弹性超声值。结果达到“功能性治愈”时,2组患者ALT、AST、TBil水平与抗-HBs、HBeAg阳性率比较差异均无统计学意义(P>0.05)。随访6、12、24个月,2组患者ALT、AST、TBil水平与HBV-DNA载量及抗-HBs、HBeAg阳性率比较差异均无统计学意义(P>0.05)。随访24个月,2组复发率、原发性肝癌发生率、肝弹性超声值比较差异均无统计学意义(P>0.05)。结论乙型肝炎肝硬化代偿期患者达到“功能性治愈”后可考虑停止NAs的使用。

无创诊断与代偿期乙型肝炎肝硬化患者中医证型的相关性分析

目的:分析无创诊断与代偿期乙型肝炎肝硬化患者中医证型的相关性。方法:回顾性分析2018年5月至2021年12月就诊于河南中医药大学第一附属医院的359例代偿期乙型肝炎肝硬化患者的临床资料,采集患者的中医证型、血常规、肝功能、Fibroscan肝脏硬度值(LSM)、肝胆脾胰彩超报告等,计算无创诊断模型中天门冬氨酸氨基转移酶(AST)和血小板比率指数(APRI)、肝纤维化4因子指数(FIB-4)、红细胞体积分布宽度(RDW)和血小板计数(PLT)比值(RPR)。无创诊断与分析中医证型的相关性,采用受试者工作特征曲线(ROC)评价无创模型对中医证型的诊断价值,De Long法对无创模型ROC曲线下面积准确性进行比较。结果:359例代偿期乙型肝炎肝硬化患者中医证型可分为肝郁脾虚证(n=189)、肝胆湿热证(n=75)、瘀血阻络证(n=70)、肝肾阴虚证(n=10)、脾肾阳虚证(n=15)6种证型。肝郁脾虚证、肝胆湿热证和瘀血阻络证患者除年龄外,在Alb、ALT、AST、PLT、门静脉内径和RDW差异有统计学意义(P<0.05)。4种无创诊断在肝郁脾虚证、肝胆湿热证和瘀血阻络证依次增高且差异有统计学意义(P<0.05)。ROC显示LSM评估肝郁脾虚证的诊断价值优于其他3种诊断方法,LSM值和APRI评估肝胆湿热证的诊断价值优于其他诊断方法,LSM值和RPR评估瘀血阻滞证的诊断价值优于其他诊断方法。结论:4种无创诊断与代偿期乙型肝炎肝硬化患者不同中医证型存在相关性,且在诊断不同中医证型时具有不同的诊断效能。

鳖甲煎丸联合恩替卡韦治疗代偿期乙肝肝硬化的效果分析

目的:分析鳖甲煎丸联合恩替卡韦治疗代偿期乙肝肝硬化的效果。方法:选取2020年6月—2021年6月徐州市传染病医院收治的代偿期乙肝肝硬化患者84例作为研究对象,采用随机数字表法分为对照组和观察组,各42例。两组均常规进行保肝、降酶治疗,对照组在此基础上给予恩替卡韦治疗,观察组在对照组基础上联合鳖甲煎丸治疗。比较两组治疗效果。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.026)。治疗后,两组胁肋疼痛、肝脾肿大、脘闷腹胀、食欲不振、神疲乏力积分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组天门冬氨酸氨基转移酶、总胆红素水平低于治疗前,且观察组低于对照组,白蛋白水平高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组透明质酸酶、层粘连蛋白、Ⅳ型胶原、Ⅲ型前胶原水平低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论:鳖甲煎丸联合恩替卡韦治疗代偿期乙肝肝硬化的效果显著,可改善患者临床症状及肝功能、肝纤维化指标。

恩替卡韦联合扶正化瘀胶囊治疗对代偿期慢性乙型肝炎肝硬化患者肝功能及纤维化指标的影响

目的 恩替卡韦联合扶正化瘀胶囊治疗对代偿期慢性乙型肝炎肝硬化患者肝功能及纤维化指标的影响。方法 120例代偿期慢性乙型肝炎肝硬化患者,随机分为实验组和对照组,每组60例。对照组接受单纯恩替卡韦胶囊治疗,实验组在对照组的基础上接受扶正化瘀胶囊治疗。比较两组患者治疗后肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、白蛋白(ALB)、凝血酶原活动度(PTA)]、肝纤维化四项指标[Ⅳ型胶原(CⅣ)、层粘连蛋白(LN)、Ⅲ型前胶原N端肽(PⅢNP)、透明质酸(HA)]、肝脾影像学指标(门静脉主干内径、脾厚度)与Stiffne值。结果 治疗后,实验组患者ALT(37.12±6.98)U/L、AST(30.74±9.59)U/L、TBIL(26.15±5.03)μmol/L、ALB(37.29±4.81)g/L、PTA(74.82±15.22)%均优于对照组的(51.12±10.05)U/L、(36.68±9.87)U/L、(31.52±5.16)μmol/L、(31.92±4.91)g/L、(66.65±15.13)%,差异均具有统计学意义(P<0.05)。治疗后,实验组患者CⅣ(112.35±11.56)μg/L、LN(92.28±5.12)μg/L、PⅢNP(15.58±0.67)μg/L、HA(93.59±13.16)ng/ml均优于对照组的(145.59±10.15)μg/L、(118.51±5.67)μg/L、(18.52±0.61)μg/L、(118.59±14.15)ng/ml,差异均具有统计学意义(P<0.05)。治疗后,实验组患者的门静脉主干内径(1.01±0.42)cm、脾厚度(3.71±0.72)cm以及Stiffne值(8.21±8.03)均小于对照组的(1.20±0.51)cm、(4.11±0.50)cm、(12.84±9.02),差异均有统计学意义(P<0.05)。结论 恩替卡韦联合扶正化瘀胶囊治疗代偿期慢性乙型肝炎肝硬化患者,可有效改善患者肝功能指标和肝纤维化四项指标,值得推广。

积聚1号方治疗乙肝肝硬化代偿期气滞瘀阻证疗效机制的理论探讨

乙肝肝硬化是由各种因素导致慢性肝损害的一类晚期肝纤维化疾病,是由损伤的肝细胞反复自我修复引起纤维沉积所致。在临床上乙肝肝硬化为发病率较高的肝脏疾病之一,因长期感染乙肝病毒引起损伤的弥漫性肝组织损害、网状蛋白支持结构塌陷、肝组织发生变性坏死、肝细胞(剩余存活)结节性再生、结缔组织增生而纤维隔形成,进一步破坏肝小叶结构,而形成假小叶,导致肝脏慢性变硬和变形,肝硬化最终发生。慢性乙型病毒性肝炎侵袭机体,并提供复制使疾病发生进展,最终会发展为肝癌,对患者生命造成威胁。现阶段,针对该病以慢性乙型病毒性肝炎复制抑制剂为主要治疗方式,可使病程进展延缓,可控制疾病,临床上治疗是以抗病毒、抗肝纤维化、免疫抑制剂、护肝降酶、退黄、降低门脉压力为主。中医药的治疗优势越来越明显,也为肝脏疾病的治疗提供了更多的可能,中医临床治疗经验也越来越丰富。中医药不但可使疾病进展延缓,可对并发症防治,同时可对肝功能发挥保护作用。积聚1号方由柴胡疏肝散合膈下逐瘀汤加减而来,该方理论方药丰富,运用行气活血、祛瘀通络之法,契合乙肝肝硬化代偿期气机不利、肝之脉络为瘀血所阻滞的病理机制,其疗效得到广大医生和患者的认可。本文从乙肝肝硬化病机病因出发,进一步研究积聚1号方的临床效果和基本方义与药理,以便为乙肝肝硬化治疗提供一种可靠的中医治疗方法。

粒细胞集落刺激因子联合聚乙二醇干扰素α-2b、利巴韦林治疗中性粒细胞绝对值减少丙肝肝硬化代偿期患者的临床观察

目的评价粒细胞集落刺激因子(G-CSF)联合聚乙二醇干扰素α-2b(PegIFNα-2b)、利巴韦林治疗中性粒细胞绝对值≤1.00×109/L丙肝肝硬化代偿期患者的有效性、安全性。方法 24例中性粒细胞绝对值≤1.00×109/L丙肝肝硬化代偿期患者,予皮下注射PegIFNα-2b 80μg/周(体重<60 kg,剂量为50μg/周)和口服利巴韦林(300 mg,3次/d),应用PegIFNα-2b前后1天各皮下注射G-CSF 200μg,治疗24周并随访24周。结果 7例因依从性差、1例因严重皮疹而终止治疗。余16例患者完成治疗和随访,其中仅1例出现轻度胸骨疼痛,无1例出现肝功能失代偿或严重感染。在应用G-CSF后,中性粒细胞绝对值即升至干扰素适应范围内;治疗期间每周第7天平均中性粒细胞绝对值为(1.49±0.32)×109/L;治疗结束后第12、24周中性粒细胞绝对值与抗病毒治疗前比较无差异(P>0.05)。治疗后谷丙转氨酶(ALT)恢复正常。早期病毒学应答率、治疗终点病毒学应答率、持续病毒学应答率分别为81.2%、75.0%、62.5%。结论 G-CSF联合PegIFNα-2b、利巴韦林抗病毒治疗可有效、安全地应用于中性粒细胞绝对值减少丙肝肝硬化代偿期患者。

恩替卡韦治疗代偿期和失代偿期乙肝肝硬化疗效比较

目的观察恩替卡韦(ETV)治疗代偿期和失代偿期乙肝肝硬化患者的抗病毒效果。方法 108例乙肝肝硬化患者均采用ETV治疗,其中代偿期患者63例(代偿期组),失代偿期患者45例(失代偿期组),两组均治疗96周,比较两组患者治疗前后不同时间的肝功能、HBV DNA、Child-pugh积分等指标的变化。结果治疗后第24、48、96周,两组患者的白蛋白(ALB)、胆碱酯酶(Ch E)、谷丙转氨酶(ALT)、Child-pugh评分、HBV-DNA检测值均较治疗前逐渐好转且差异均具有统计学意义(P<0.05);治疗前、治疗第24、48、96周代偿期组患者的ALB、CHE、ALT、Child-pugh评分、HBV-DNA检测值均明显优于失代偿期组,差异均具有统计学意义(P<0.05);代偿期组治疗后第96周与治疗前的ALB、CHE、ALT、Child-pugh评分、HBV-DNA检测值差值绝对值均高于失代偿期组,差异均具有统计学意义(P<0.05);代偿期组的ALT复常率为96.83%,HBV-DNA转阴率为93.65%,均明显高于失代偿期组,差异均具有统计学意义(P<0.05)。治疗过程中,代偿期组的上消化道出血率为3.17%,明显低于失代偿期组的17.78%,差异具有统计学意义(P<0.05)。结论 ETV在治疗代偿期和失代偿期乙肝肝硬化患者中均具有改善肝功能,降低HBV-DNA病毒载量的效果,但治疗代偿期患者的效果更佳显著。

恩替卡韦对肝硬化失代偿期、代偿期及慢性乙型肝炎患者的2年抗病毒临床疗效对比

目的研究恩替卡韦治疗肝硬化失代偿期、代偿期及慢性乙型肝炎患者的疗效差异,为临床不同阶段肝硬化和慢性乙型肝炎患者的治疗提供正确指导。方法随机选取本院收治的肝硬化失代偿期患者20例、肝硬化代偿期患者18例及初治慢性乙型肝炎患者38例,三组患者均采用恩替卡韦进行抗病毒治疗,并随访观察。对三组患者治疗前后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乙型肝炎病毒e抗原(HBeAg)、HBV DNA定量、胆碱酯酶(CHE)、血清总胆红素(TBIL)、血清白蛋白(ALB)等指标的变化情况进行比较。结果三组患者各指标治疗前比较差异均无显著性(P>0.05)。治疗后三组患者ALT、AST、HBV DNA、TBIL水平均较治疗前明显下降,且治疗前后组内比较差异具有显著性(P<0.05);三组患者HBeAg、CHE、ALB水平与治疗前比较均明显上升,差异具有显著性(P<0.05);三组患者治疗后各指标比较差异均无显著性(P>0.05)。结论临床采用恩替卡韦治疗肝硬化失代偿期、代偿期及慢性乙型肝炎均具有较好的恢复肝功能、降低病毒载量的功效,且治疗各期肝硬化的疗效无显著差异。